Resting-State Functional Connectivity and Cognition After Major Cardiac Surgery in Older Adults without Preoperative Cognitive Impairment: Preliminary Findings.
Abstract
OBJECTIVES: To look for changes in intrinsic functional brain connectivity associated
with postoperative changes in cognition, a common complication in seniors undergoing
major surgery, using resting-state functional magnetic resonance imaging. DESIGN:
Objective cognitive testing and functional brain imaging were prospectively performed
at preoperative baseline and 6 weeks after surgery and at the same time intervals
in nonsurgical controls. SETTING: Academic medical center. PARTICIPANTS: Older adults
undergoing cardiac surgery (n = 12) and nonsurgical older adult controls with a history
of coronary artery disease (n = 12); no participants had cognitive impairment at preoperative
baseline (Mini-Mental State Examination score >27). MEASUREMENTS: Differences in resting-state
functional connectivity (RSFC) and global cognitive change relationships were assessed
using a voxel-wise intrinsic connectivity method, controlling for demographic factors
and pre- and perioperative cerebral white matter disease volume. Analyses were corrected
for multiple comparisons (false discovery rate P < .01). RESULTS: Global cognitive
change after cardiac surgery was significantly associated with intrinsic RSFC changes
in regions of the posterior cingulate cortex and right superior frontal gyrus-anatomical
and functional locations of the brain's default mode network (DMN). No statistically
significant relationships were found between global cognitive change and RSFC change
in nonsurgical controls. CONCLUSION: Clinicians have long known that some older adults
develop postoperative cognitive dysfunction (POCD) after anesthesia and surgery, yet
the neurobiological correlates of POCD are not well defined. The current results suggest
that altered RSFC in specific DMN regions is positively correlated with global cognitive
change 6 weeks after cardiac surgery, suggesting that DMN activity and connectivity
could be important diagnostic markers of POCD or intervention targets for potential
POCD treatment efforts.
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http://hdl.handle.net/10161/13329Published Version (Please cite this version)
10.1111/jgs.14534Publication Info
(2017). Resting-State Functional Connectivity and Cognition After Major Cardiac Surgery in Older Adults without Preoperative Cognitive Impairment: Preliminary Findings. J Am Geriatr Soc, 65(1). pp. e6-e12. 10.1111/jgs.14534. Retrieved from http://hdl.handle.net/10161/13329.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
John Hunter Peel Alexander
Professor of Medicine
John H. Alexander, MD, MHS is a cardiologist and Professor of Medicine in the Department
of Medicine, Division of Cardiology at Duke University School of Medicine, as well
as the Vice Chief, Clinical Research in the Division of Cardiology. He is the Director
of Cardiovascular Research at the Duke Clinical Research Institute where he oversees
a large group of clinical research faculty and a broad portfolio of cardiovascular
clinical trials and observational clinical research programs. He is a
Miles Berger
Assistant Professor of Anesthesiology
My research team focuses on understanding the cause of postoperative cognitive dysfunction
(POCD) and delirium, and whether these disorders are caused by perioperative changes
in Alzheimer's disease pathways. We are also interested in whether delirium or POCD
are associated with an increased long term risk of developing Alzheimer's disease.
Towards these ends, we use a combination of methods including cognitive testing, CSF
and blood sampling, functional neuroimaging, and rigorous biochemical as
Jeffrey Nicholas Browndyke
Associate Professor in Psychiatry and Behavioral Sciences
Dr. Browndyke is an Associate Professor of Geriatric Behavioral Health in the Department
of Psychiatry & Behavioral Sciences. He also holds affiliate faculty appointments
with the Duke Brain Imaging & Analysis Center (BIAC), Duke Institute for Brain Science
(DIBS), Center for Cognitive Neuroscience (CCN), and the Duke Center for Geriatric
Surgery. He has dual appointment to the Duke University Medical Center and the Durham
VA Medical Center, the latter of which is where his c
Jeffrey Giles Gaca
Associate Professor of Surgery
Todd Brenson Harshbarger
Medical Center Instructor in the Center for Brain Imaging and Analysis
Joseph P. Mathew
Jerry Reves, M.D. Professor of Cardiac Anesthesiology
Current research interests include:1. The relationship between white matter patency,
functional connectivity (fMRI) and neurocognitive function following cardiac surgery.2.
The relationship between global and regional cortical beta-amyloid deposition and
postoperative cognitive decline.3. The effect of lidocaine infusion upon neurocognitive
function following cardiac surgery.4. The association between genotype and outcome
after cardiac surgery.5. Atrial fibrillation
Mark Franklin Newman
Professor Emeritus of Anesthesiology
Best known for his work in assessing and improving clinical outcomes and quality of
life following cardiac surgery, Dr. Mark Newman is President of the Duke Private Diagnostic
Clinic (The Duke Faculty Practice Organization) and the Merel H. Harmel Professor
of Anesthesiology at Duke University Medical Center. In addition, Dr. Newman developed
the Multicenter Perioperative Outcomes Research Group of the Duke Clinical Research
Institute established at Duke in 2001 to further the study of strategie
Patrick J Smith
Associate Professor in Psychiatry and Behavioral Sciences
Dr. Smith is interested in the impact of lifestyle interventions, such as diet and
exercise, on neurocognitive function and mood. He has also published multiple studies
examining the relationship between cardiovascular disease, major depressive disorder,
and neurocognitive outcomes, preoperative predictors of postoperative delirium, the
impact of cardiothoracic interventions on neurocognitive outcomes, and the relationship
between patterns of dietary intake and cardiovascular outcomes. He is als
Kathleen Anne Welsh-Bohmer
Professor of Psychiatry and Behavioral Sciences
Dr. Kathleen Welsh-Bohmer is a Professor of Psychiatry with a secondary appointment
in the Department of Neurology. She is also the Chief of the Medical Psychology CPU,
the professional home for the over 200 academic psychologists within Duke Medical
Center. Clinically trained as a neuropsychologist, Dr. Welsh-Bohmer's research activities
have been focused around developing effective prevention and treatment strategies
to delay the onset of
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